[Endoscopic spine surgery for disc disease and lumbar spinal stenosis]

Alfie V, Bardach A, Alcaraz A, Pichon-Riviere A, Augustovski F, García Martí S,Ciapponi A.
Record ID 32018001585
Original Title: Cirugía endoscópica de columna en patología discal y canal estrecho lumbar
Authors' recommendations: High-quality evidence suggests that, for surgical treatment of lumbar disc herniation, percutaneous endoscopic discectomy, when compared with microdiscectomy surgery, shows similar clinical outcomes in terms of lumbar and radiating pain resolution and function improvement. The incidence of complications is similar in both technologies at short and middle-term. The endoscopic approach is associated with fewer hospitalization days and considerably earlier return to work. Even though endoscopic surgery is associated with a shorter surgical time and less intraoperative blood loss, the clinical relevance of these finding remains uncertain. Moderate-quality evidence suggests that in surgical treatment of lumbar spinal stenosis, endoscopic decompression (biportal) when compared with microscope-assisted decompression would attain similar clinical outcomes with no major incidence of complications. The advantages associated with the endoscopic approach were also shorter surgical time, fewer hospitalization days and earlier return to work. In relation to lumbar disc disease, the clinical practice guideline from the American Society of Spine and the United Kingdom National Institute for Health and Care Excellence (NICE) mention this technology as a surgical alternative. In the case of NICE, it is clarified that it should be carried out by minimally-invasive endoscopic surgery-trained staff. In contrast, the clinical practice guideline from Chile’s Ministry of Health and a Belgian guideline do not recommend the endoscopic approach for treating lumbar disc herniation. An American consensus of experts in minimally invasive spinal surgery, in its lumbar stenosis treatment guide, does not mention endoscopic treatment. Endoscopic spinal surgery is covered by Colombia’s public health system in both indications. The rest of the Latin American public health systems consulted do not cover it and it is not included in the Mandatory Medical Program or Unique Reimbursement System in Argentina. The United Kingdom public funder covers this technology for disc disease, but it does not include lumbar spinal stenosis. Medicare, the public health funder in the United States, covers this technology only if evidence on its use from a patient participating in a research protocol is obtained. One United States private funder covers it for endoscopic disc decompression and lumbar stenosis decompression. The rest of the United States private funders consulted do not cover this technology. One economic assessment performed in a high-income country, showed that for lumbar disc disease, endoscopic discectomy proved to be a cost-saving technique. However, it should be considered that the main cost associated with the procedure comes from purchasing and maintaining the equipment required to perform it. No similar studies carried out at local level are available.
Project Status: Completed
Year Published: 2020
URL for published report: https://www.iecs.org.ar/home-ets/
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Argentina
MeSH Terms
  • Spinal Diseases
  • Back Pain
  • Low Back Pain
  • Lumbar Vertebrae
  • Spinal Stenosis
  • Minimally Invasive Surgical Procedures
  • Endoscopy
  • Decompression, Surgical
Organisation Name: Institute for Clinical Effectiveness and Health Policy
Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name: info@iecs.org.ar
Contact Email: info@iecs.org.ar
Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.